Horm Metab Res 2005; 37(8): 494-499
DOI: 10.1055/s-2005-870308
Original Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Thyroid Dysfunction in Adult Long-term Survivors After Hemapoeitic Stem-cell Transplantation (HSCT)

M.  Somali1 , V.  Mpatakoias1 , A.  Avramides2 , I.  Sakellari2 , Ch.  Smias2 , A.  Anagnostopoulos2 , A.  Papachristou3 , A.  Antoniadou3
  • 1 Department of Endocrinology, Hippocratio General Hospital Thessaloniki, Greece
  • 2Department of Haematology, George Papanicolaou General Hospital, Thessaloniki, Greece
  • 3 Department of Biochemistry, Hippocratio General Hospital, Thessaloniki, Greece
Further Information

Publication History

Received 30 August 2004

Accepted after revision 3 February 2005

Publication Date:
01 September 2005 (online)

Abstract

Thyroid function was evaluated in 72 adult survivors (41 females and 31 males) at 16 to 56 years of age, 1.5 years mean time (range 0.2 - 9.8) after hemapoeitic stem cell transplantation (HSCT) with no known prior history of thyroid dysfunction. Thyroid stimulating hormone (TSH) and free thyroxin levels (FT4) were determined before and after stimulation with thyrotropin releasing hormone (TRH). Conditioning regimens for HSCT did not include TBI. Overt hypothyroidism (basal TSH > 8 μIU/ml, FT4 < 0.8 ng/dl) was observed in 6 % of male patients and 5 % of female patients; subclinical hypothyroidism (basal TSH 4 - 8 μIU/ml, low normal FT4 0.8 - 1.9 ng/dl) was observed in 13 % of males and 5 % of females. A significant number of euthyroid patients (40 % males and 54 % females) with normal basal TSH and FT4 levels overresponded to TRH stimulation; the finding being statistically significant (p < 0.005). A heavy TSH response after TRH stimulation indicates compensated subclinical dysfunction of the thyroid gland. Chemotherapy-only conditioning regimens may have an adverse effect on thyroid gland function not always detected by determination of basal TSH and FT4 levels. This finding warrants long-term evaluation of thyroid function in HSCT patients.

References

  • 1 Kauppila M, Koskinen P, Irjala K, Remes K, Viikari J. Long-term effects of allogenic bone marrow transplantation (BMT) on pituitary, gonad, thyroid and adrenal function in adults.  Bone Marrow Transpl. 1998;  22 331-337
  • 2 Tauchmanova L, Selleri C, de Rosa G, Pagano L, Orio F, Lombardi G, Rotoli B, Colao A. High prevalence of endocrine dysfunction in long-term survivors after allogenic bone marrow transplantation for hematological diseases.  Cancer. 2002;  95 1076-1084
  • 3 Kolb H J, Bender-Gotze C. Late complications after allogenic bone marrow transplantation for leukaemia.  Bone Marrow Transpl. 1990;  6 61-72
  • 4 Larsen P R, Davies T F, Hay I D. The Thyroid Gland. In: Jean D, Wilson JD Foster DW, Kronenberg HM, Larsen PR (eds) Williams Textbook of Endocrinology, 9th edition. Philadelphia; W. B. Saunders company 1998: 389-517
  • 5 Refetoff S. Thyroid function tests and effects of drugs on thyroid function. In: De Groot LJ (ed) Endocrinology. Philadelphia; W. B. Saunders company 1989: 590-640
  • 6 Dufour D R, Gaskin J H, Jubiz W A. Dynamic Procedures in Endocrinology. In: Becker KL (ed) Principles and Practice of Endocrinology and Metabolism. Philadelphia; J. B. Lipincott Company 1990: 1766-1775
  • 7 Al-Fiar F Z, Colwill R, Lipton J H, Fyles G, Spaner D, Messner H. Abnormal thyroid stimulating hormone (TSH) levels in adults following allogenic bone marrow transplants.  Bone Marrow Transpl. 1997;  19 1019-1022
  • 8 Katsanis E, Shapiro R S, Robison L L, Haake R J, Kim T, Pescovitz O H, Ramsay N KC. Thyroid dysfunction following bone marrow transplantation: long-term follow-up of 80 pediatric patients.  Bone Marrow Transpl. 1990;  5 335-340
  • 9 Cohen A, Rovelli R, Zecca S, VanLint M T, Parodi L, Grasso L, Uredzo C. Endocrine late effects in children who underwent bone marrow transplantation: review.  Bone Marrow Transpl. 1998;  21 (Suppl 2) 564-567
  • 10 Lee W Y, Oh E S, Min C K, Kim D W, Lee J W, Kang M I, Min W S, Cha B Y, Lee K W, Son H Y, Kang S K, Kimm C C. Post transplant complications. Changes in autoimmune thyroid disease following allogenic bone marrow transplantation.  Bone Marrow Transpl. 2001;  28 63-66
  • 11 Brennan B, Shalet S M. Endocrine late effects after bone marrow transplant.  Br J Haematol. 2002;  118 58-66
  • 12 Utiger R D. Hypothyroidism. In: De Groot LJ (ed) Endocrinology Philadelphia; W. B. Saunders company 1989: 702-722

Maria Somali, M. D.

Department of Endocrinology, Hippocratio General Hospital

Constantinoupoleos 49 · 54646 Thessaloniki · Greece

Phone: +30 (2310) 235 711 or 892 038

Fax: +30 2310 235 711 ·

Email: somali@otenet.gr